METHODS: We reanalyzed the empirical data from the Health Insurance Plan trial in 1963 to the UK age trial in 1991 and their follow-up data published until 2015. We first performed Bayesian conjugated meta-analyses on the heterogeneity of attendance rate, sensitivity, and over-detection and their impacts on advanced stage breast cancer and death from breast cancer across trials using Bayesian Poisson fixed- and random-effect regression model. Bayesian meta-analysis of causal model was then developed to assess a cascade of causal relationships regarding the impact of both attendance and sensitivity on 2 main outcomes.
RESULTS: The causes of heterogeneity responsible for the disparities across the trials were clearly manifested in 3 components. The attendance rate ranged from 61.3% to 90.4%. The sensitivity estimates show substantial variation from 57.26% to 87.97% but improved with time from 64% in 1963 to 82% in 1980 when Bayesian conjugated meta-analysis was conducted in chronological order. The percentage of over-detection shows a wide range from 0% to 28%, adjusting for long lead-time. The impacts of the attendance rate and sensitivity on the 2 main outcomes were statistically significant. Causal inference made by linking these causal relationships with emphasis on the heterogeneity of the attendance rate and sensitivity accounted for the variation in the reduction of advanced breast cancer (none-30%) and of mortality (none-31%). We estimated a 33% (95% CI: 24-42%) and 13% (95% CI: 6-20%) breast cancer mortality reduction for the best scenario (90% attendance rate and 95% sensitivity) and the poor scenario (30% attendance rate and 55% sensitivity), respectively.
CONCLUSION: Elucidating the scenarios from high to low performance and learning from the experiences of these trials helps screening policy-makers contemplate on how to avoid errors made in ineffective studies and emulate the effective studies to save women lives.
METHODS: A desk review was conducted from August to October in 2018, to examine, review and describe the historical perspective, strategic planning and implementation of the current CRC screening program in Malaysia.
RESULTS: The main policy documents related to CRC screening are the National Strategic Plan for Cancer Control Programme 2016-2020, the Clinical Practice Guideline for Management of Colorectal Carcinoma 2017, and the Implementation Guideline for CRC Screening in Malaysia 2014. Several papers have been published on the epidemiology of CRC in Malaysia. Between 2014 and 2018, 127,957 men and women were screened using immunochemical Faecal Occult Blood Test (iFOBT); 9.3% had positive iFOBT results and were referred for colonoscopy. For those who underwent colonoscopy, CRC detection rate was 4.1% and 13.9% for pre-malignant conditions. Barriers were identified along the continuum of screening process, including patient, provider, and system factors.
CONCLUSION: Although population-level organised screening programmes are preferable to opportunistic screening, the CRC programme in Malaysia was tailored to meet the needs of the population based on available existing resources. A well-mapped budget for the entire screening programme continuum, a strong partnership between stakeholders and an opportunistic screening strategy is crucial to address the rising incidence of CRC.
METHODS: A total of 800 cervical scrapings were taken by cytobrush and placed in ThinPrep medium. The samples were dried over infrared transparent matrix. Beams of infrared light were directed at the dried samples at frequency of 4000 to 400 cm(-1). The absorption data were produced using a Spectrum BX II FTIR spectrometer. Data were compared with the reference absorption data of known samples using FTIR spectroscopy software. FTIR spectroscopy was compared with cytology (gold standard).
RESULTS: FTIR spectroscopy could differentiate normal from abnormal cervical cells in the samples examined. The sensitivity was 85%, specificity 91%, positive predictive value 19.5% and negative predictive value of 99.5%.
CONCLUSION: This study suggests that FTIR spectroscopy could be used as an alternative method for screening for cervical cancer.